The goal of this proposal is to improve the care and safety of residents of nursing homes (NHs) in rural areas of Utah by addressing the growing problem of antibiotic resistance and inappropriate antibiotic use in this setting. Antibiotics are heavily used in nursing homes, and the selection pressure exerted by this level of antibiotic use, particularly in a contained environment, is enormous. Not surprisingly, antibiotic resistance in NHs and the risk of infection with an antibiotic-resistant organism are rising. This is of particular concern in a clinical setting where elderly residents already have a significantly increased risk of infection. The focus of this work will be antibiotic resistance among gram-negative urinary isolates and the management of catheter-associated bacteriuria and urinary tract infections (UTI) in the rural NH setting. It is hypothesized that the problems of antibiotic resistance and inappropriate antibiotic use are considerable in rural NHs, where little is known about management practices and surveillance is rarely, if at all, performed. These hypotheses will be investigated by two approaches. The first will employ a personal digital assistant (PDA)-based surveillance tool at NHs throughout rural Utah to track antimicrobial resistance among gram-negative urinary isolates, particularly those from long-term catheterized patients. The second will use a similar PDA-based tool to prospectively assess management of bacteriuria and UTI in long-term catheterized patients from rural Utah NHs. These studies will lay the groundwork for a third project, where the candidate will implement an intervention using a PDA-based decision-support tool to improve the management of catheter-associated asymptomatic bacteriuria and symptomatic urinary tract infection for residents of rural SNFs, emphasizing its impact on patient care, patient safety, and overall costs. This project is an ideal blend of observational and interventional epidemiology with the tools and techniques of medical informatics, applying them to the enormous clinical problem of antibiotic use and resistance in the NH setting. The NIH-funded K30 program at the University of Utah, along with the outstanding mentorship and research group assembled, will provide a superb educational and research environment for the mastering of these techniques as well as for maximizing the potential of this project and this candidate.